| NPI | 1992204226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MA059685) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004423) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2018-03-28 |