| NPI | 1013905793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-383) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID PA383) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2016-09-12 |