| NPI | 1851940381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9112463) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL 9112463) |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2022-04-25 |