| NPI | 1194028993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA11172) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA21337) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2022-02-22 |