| NPI | 1952409203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA09393) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0002670) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-07-01 |