| NPI | 1508886169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MA003054L) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA003054L) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-18 |