| NPI | 1750492849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PA101919) |
| 208800000X Urology (Licence: FL PA101919) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-03-17 |