| NPI | 1417287541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 1097) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: 1097) |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TX 1097) | |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2015-07-26 |