| NPI | 1538783972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 13390122-1206) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2023-09-05 |