| NPI | 1528048071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA04069) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: TX PA04069) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2019-03-25 |