| NPI | 1356394514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM 96-PA07) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM 96-PA07) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-03-02 |