| NPI | 1902252463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA PA53376) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-04-27 |