| NPI | 1922299577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05311) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA21658) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2016-03-10 |