| NPI | 1326067604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1380) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA PA10004189) |
| 363A00000X Physician Assistant (Licence: WA PA10004189) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-08-16 |