| NPI | 1851587133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 4859842-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 4859842-1206) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2009-04-13 |