| NPI | 1982978482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08326) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PA-470) |
| 363A00000X Physician Assistant (Licence: OK 2146) | |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2018-08-01 |