| NPI | 1407972649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA15779) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA15152) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-05-25 |