| NPI | 1568447761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104979) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX 1034917) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2009-08-31 |