| NPI | 1619552866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 115981) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA 115981) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2026-01-27 |