| NPI | 1124642970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9113431) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL 9113431) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-07 |
| Last Update Date | 2022-04-25 |