| NPI | 1598734899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA09738) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: 1046213) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2023-06-01 |