| NPI | 1881695112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA03029) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TX PA03029) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2015-05-01 |