| NPI | 1922381219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA09671) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015091) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2024-10-10 |