| NPI | 1679734206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02042) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 0010-02042) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2022-07-21 |