| NPI | 1982718789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA04538) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04538) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA04538) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2017-01-09 |