| NPI | 1497867907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-02309) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05201) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-06-09 |