| NPI | 1477671683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3323) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 1032) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA03327) | |
| 363AS0400X Physician Assistant, Surgical (Licence: AR PA-226) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2025-09-17 |