| NPI | 1447629233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10521) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL 9109049) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2016-11-04 |