| NPI | 1841690096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant | |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2024-04-03 |