| NPI | 1700896966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 1499) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 1499) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-06-18 |