| NPI | 1942376520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08452) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 368) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2016-05-10 |