| NPI | 1558671727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO SA0001027) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00199) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2017-12-03 |