| NPI | 1013097963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100907) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 100907) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-09-26 |