| NPI | 1063829596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10759) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 017753) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2020-12-30 |