| NPI | 1801438270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 50.006213RX) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2020-09-30 |