| NPI | 1518226356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12692) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IL 085005389) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2023-08-28 |