| NPI | 1619327764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NV PA0000) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA1754) |
| 363AM0700X Physician Assistant, Medical (Licence: NV PA0000) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2023-09-13 |