| NPI | 1962479196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: HI AMD-1379) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA02915) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2024-08-26 |