| NPI | 1932660362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15744) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA031640) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-08-07 |