| NPI | 1881009579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA14927) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 017575) |
| 363A00000X Physician Assistant (Licence: NV PA1734) | |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2022-10-13 |