| NPI | 1487772307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00020) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00020) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2024-04-08 |