| NPI | 1932403649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07034) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002549) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA054656) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2014-07-02 |