| NPI | 1336119916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA15805) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10004751) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004751) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-03-29 |