| NPI | 1144469552 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 005529) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 5529) | 
| 363AM0700X Physician Assistant, Medical (Licence: GA 005529) | |
| Enumeration Date | 2009-02-09 | 
| Last Update Date | 2025-08-13 |