| NPI | 1831384866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WY 230) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY WY230) |
| 207X00000X Orthopaedic Surgery (Licence: WY WY230) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2018-04-18 |