| NPI | 1952466500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 2891) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12265) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2023-02-09 |