| NPI | 1316530587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113777) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL PA9113777) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-04-15 |