| NPI | 1275224388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA16887) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-06-15 |