| NPI | 1861557894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: HI AMD-669) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: HI Amd669) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: HI AMD669) | |
| 363A00000X Physician Assistant (Licence: WA PA10004553) | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA10004553) | |
| 363AM0700X Physician Assistant, Medical (Licence: HI AMD-669) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2021-08-25 |