| NPI | 1871861088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09011) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015449-1) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2014-09-01 |