| NPI | 1063926186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6380) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA PA6380) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2020-06-27 |