| NPI | 1871684431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04663) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA 04663) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-10-17 |