| NPI | 1417099441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA06392) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA9103955) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2022-05-16 |