| NPI | 1528391901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06243) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06243) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2022-02-19 |