| NPI | 1083621569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03657) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX PA03657) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2012-09-17 |