| NPI | 1992970511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08292) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011811) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2013-05-28 |