| NPI | 1518323146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10402) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2022-03-07 |