| NPI | 1962135509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1333) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15340) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2024-09-06 |