| NPI | 1538838271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA15259) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA15259) |
| 363A00000X Physician Assistant (Licence: TN 4725) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2022-09-07 |