| NPI | 1639268006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA03715) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX PA03715) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-07-08 |