| NPI | 1659603835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX 07791) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2014-01-31 |