| NPI | 1609083724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL CN 2545) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other Orthopedic Assistant (Licence: FL 1131) |
| 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: VA 0136000230) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2024-07-08 |