| NPI | 1649309410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA07915) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM PA20070012) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2022-10-23 |