| NPI | 1922060284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 105738-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 2209) |
| 363AM0700X Physician Assistant, Medical (Licence: TX T12/22/2013) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2017-01-26 |