| NPI | 1124423611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL 1118529) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 11767) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2024-03-26 |