| NPI | 1578226387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063090) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PA MA063090) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-12-15 |