| NPI | 1750634754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207RP1001X Internal Medicine Pulmonary Disease (Licence: GA 6639) |
| 207X00000X Orthopaedic Surgery (Licence: GA 6639) | |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma (Licence: GA 6639) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2024-03-29 |