| NPI | 1669851721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR applied) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OR PA179379) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2025-08-21 |