| NPI | 1295205813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA12550) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA12550) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2023-06-02 |