| NPI | 1154086049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15081) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2022-10-28 |