| NPI | 1205842143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA03842) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OK 1911) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2017-11-15 |