| NPI | 1215458294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4042) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WI 4042-23) |
| 363A00000X Physician Assistant (Licence: AZ 9957) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2023-11-02 |