| NPI | 1790930527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: AZ 4914) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 4914) |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2021-07-03 |