| NPI | 1962586636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04038) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA179) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |