| NPI | 1144722372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA6469) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: MA PA6469) |
| 207X00000X Orthopaedic Surgery (Licence: MA PA6469) | |
| 363A00000X Physician Assistant (Licence: MA PA6469) | |
| 405300000X Prevention Professional (Licence: MA PA6469) | |
| Enumeration Date | 2018-03-03 |
| Last Update Date | 2021-01-22 |