| NPI | 1174298418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10742) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 10742) |
| 207X00000X Orthopaedic Surgery (Licence: GA 10742) | |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2024-10-23 |