| NPI | 1306008230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 2964) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9114250) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2021-04-01 |