| NPI | 1437719002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA13012) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13012) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-06-10 |