| NPI | 1417096819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 000058) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 58) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2016-05-02 |