| NPI | 1023359031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00695) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00695) |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2022-08-04 |