| NPI | 1871157727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX PA12720) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2021-09-13 |