| NPI | 1962780387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014907-1) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2012-11-13 |