| NPI | 1598896953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22162) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05080) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA05080) | |
| 363A00000X Physician Assistant (Licence: CA PA22162) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-02-11 |