| NPI | 1669839916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06130) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: NC 0010-06130) |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2024-03-13 |