| NPI | 1932421252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06671) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009169) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2024-08-08 |