NPI | 1982117024 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55147) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 55147) |
Enumeration Date | 2017-11-12 |
Last Update Date | 2020-04-28 |