| NPI | 1861525487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TN 650) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN 650) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-05-14 |