| NPI | 1881394443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16833) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX 747577) |
| 363A00000X Physician Assistant (Licence: AL 2170) | |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-08-20 |