| NPI | 1063848075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10100067) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS T-4299) |
| 363A00000X Physician Assistant (Licence: AL PA976) | |
| 363A00000X Physician Assistant (Licence: MS PA00186) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2026-05-28 |