| NPI | 1881162832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12287) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56115) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2019-10-08 |