| NPI | 1558340315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA06206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103848) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA06206) | |
| 363A00000X Physician Assistant (Licence: MI 5601007318) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2015-04-08 |