| NPI | 1477928208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4966) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN 4966) |
| 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: TN 4966) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085.005742) | |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 4966) | |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2022-06-16 |