| NPI | 1851541270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA06738) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4268) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2012-10-16 |