| NPI | 1801876693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2015-05-12 |