| NPI | 1750759411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 50.004526RX) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2025-01-16 |