| NPI | 1215924386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601003589) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5601003589) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2013-09-18 |