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 |