| NPI | 1528524139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12985) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX PA12985) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2021-02-24 |