| NPI | 1134546252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 11670) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA AT002249) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-10-18 |