| NPI | 1679662142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: LA PA.200159) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX PA04446) |
| 363AS0400X Physician Assistant, Surgical (Licence: LA PA.200159) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-02-25 |