| NPI | 1598779472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06861) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 0852002644) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-04-13 |