| NPI | 1023044898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA08154) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM 98-PA17) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2014-04-29 |