| NPI | 1235401662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07507) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA07507) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2024-10-22 |