| NPI | 1407271026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05848) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA08818) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2023-12-20 |