| NPI | 1952552291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10075) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19986) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2019-08-15 |