| NPI | 1306992557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA 2198) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 2198) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2011-10-13 |