| NPI | 1053335430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PAT9103767) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PAT9103767) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL PAT9103767) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-05-26 |