| NPI | 1487269080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 11797322-1206) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AR PT2025-030) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2025-03-24 |