| NPI | 1598913022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 7098483-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1881) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 1881) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2024-12-10 |