| NPI | 1255046777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA PA64269) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2024-05-01 |