| NPI | 1184984320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: UT 8324433-1206) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2021-08-18 |