| NPI | 1285888339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA07805) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA TA60061061) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA TA60061061) | |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2021-12-28 |