| NPI | 1497704290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA 02500) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA02500) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2025-07-23 |