| 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 |