NPI | 1356814644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006552) |
Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: VA 0110006552) |
Enumeration Date | 2019-01-09 |
Last Update Date | 2024-02-26 |