| NPI | 1689905853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA PA20679) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20679) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2026-05-18 |