| NPI | 1053838532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 10403324-1206) |
| Additional Taxonomies | 208800000X Urology (Licence: UT 10403324-8906) |
| 363A00000X Physician Assistant (Licence: UT 10403324-1206) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2021-12-20 |