| NPI | 1831851807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD C0008198) |
| Additional Taxonomies | 2086S0129X (Licence: MD C0008198) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2022-12-12 |