| NPI | 1659459030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05344) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA13801) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-12-05 |