| NPI | 1437890134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 0010-12217) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-08-01 |