| NPI | 1023586583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA20602) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2026-08-14 |