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 |