| NPI | 1902511629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA18138) |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2025-05-19 |