| NPI | 1659895993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008724) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 50.005155RX) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2018-07-25 |