| NPI | 1982723532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00342) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00342) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 99-216) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-01-06 |