| NPI | 1558396408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 000975) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 975) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-01-31 |