| NPI | 1982007951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10177) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018045-1) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2023-09-22 |