| NPI | 1093379471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09136) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: NC 0010-09136) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2021-04-16 |