| NPI | 1518916113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3233) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 3233) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2019-02-28 |