| NPI | 1629399753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06817) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363A00000X Physician Assistant (Licence: AZ 5379) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2014-01-10 |