| NPI | 1235796392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX SA00733) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: TX SA00733) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2020-01-03 |