| NPI | 1326294216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA14516) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA14516) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C0003804) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2024-05-22 |