| NPI | 1962559344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA052584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MA052584) |
| 207T00000X Neurological Surgery (Licence: PA MA052584) | |
| 207X00000X Orthopaedic Surgery (Licence: PA MA052584) | |
| 363A00000X Physician Assistant (Licence: PA MA052584) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2018-03-07 |