| NPI | 1952728503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX 1117296) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1117296) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2019-11-15 |