| NPI | 1740338433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA05106) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-02-10 |