| NPI | 1114971058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA04931) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA 001130) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2014-10-10 |