| NPI | 1295989630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 5182589-1206) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: UT 5182589-1206) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2023-01-03 |