| NPI | 1881033942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA650816) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.200628) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2016-11-21 |