| NPI | 1750428819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NM 66710) |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: NM 66710) |
| 208600000X Surgery (Licence: TX 241536) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1071475) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 66710) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-03-18 |