| NPI | 1235606534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA190776) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR PA190776) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2023-01-11 |