| NPI | 1073587705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03349) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH S0000670) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2016-07-19 |