| NPI | 1760507065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 4832) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 4832) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA60051173) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2022-02-17 |