| NPI | 1437209210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06783) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00092000) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 8736) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2010-12-13 |