| NPI | 1194787804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA1782) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL PA1782) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA1782) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2013-02-12 |