| NPI | 1548550015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-449) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AR PA-449) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2024-03-05 |