| NPI | 1417942632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.A10296) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA03213) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 3939) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2015-07-23 |