| NPI | 1164553772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00544) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00544) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-03-05 |