| NPI | 1265948046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA184972) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR PA184972) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2020-11-11 |