| NPI | 1851331177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001005016) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PA9101172) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-06-05 |