| NPI | 1730497348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO PA0004114) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO PA0004114) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2015-03-11 |