| NPI | 1336827435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA006519) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: PA OA006519) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA OA006519) | |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2023-07-11 |