| NPI | 1871745356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11539) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 111307) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2019-02-07 |