| NPI | 1326167172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 174400000X Specialist (Licence: TX SA00002) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2017-04-21 |