| NPI | 1386309821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA.0007158) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO PA.0007158) |
| Enumeration Date | 2021-10-31 |
| Last Update Date | 2022-02-22 |