| NPI | 1881372498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00975) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2024-12-16 |