| NPI | 1508202086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PA9107721) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2019-01-27 |