| NPI | 1235329822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05284) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05284) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2016-01-26 |