| NPI | 1316279995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13541) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 0124641) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2023-07-20 |