| NPI | 1154449973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00366) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 748767) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2014-10-09 |