| NPI | 1851723019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR PA-539) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AR PA-539) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2024-03-05 |