| NPI | 1285747261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA01849) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX PA01849) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2019-01-31 |