| NPI | 1073147153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7835) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ 7835) |
| 363AS0400X Physician Assistant, Surgical (Licence: AZ 1171058) | |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2025-02-07 |