| NPI | 1275379984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 11645) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 11645) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: AZ 11645) | |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2026-05-11 |