| NPI | 1568445070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55585) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04581) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA04581) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2025-02-11 |