| NPI | 1750852984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: VA 0110-006662) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: VA 0110-006662) | |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2022-07-08 |