| NPI | 1609537851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: VA 0110008814) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-01-09 |
| Last Update Date | 2023-05-16 |