| NPI | 1861593592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00087) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX SA00087) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-11-14 |