| NPI | 1396260147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TX PA11374) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX PA11474) |
| Enumeration Date | 2017-08-12 |
| Last Update Date | 2022-07-21 |