| NPI | 1285141333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL 1255001350) |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2024-02-29 |