| 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 |