| NPI | 1508812629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0003886) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: GA 2940) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA06207) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX PA06207) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2014-12-16 |