| NPI | 1003485806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA14900) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-06-04 |