| NPI | 1417293689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08150) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX PA08150) |
| 208000000X Pediatrics (Licence: TX PA08150) | |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2022-08-04 |