| NPI | 1124321831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07209) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: NC 0010-07209) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105809) | |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2022-07-21 |