| NPI | 1871174649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14584) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9113964) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2021-06-09 |