| NPI | 1679957369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1022) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AR PA-1022) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2024-03-05 |