| NPI | 1265551949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00313) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00313) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 03-141) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-01-09 |