| NPI | 1740807197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TX PA13952) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13952) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2023-02-10 |