| NPI | 1164082731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA13043) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2023-08-02 |