| NPI | 1487647632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06410) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 003624) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2016-06-27 |