| NPI | 1295695179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 6715) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 6715) |
| 207T00000X Neurological Surgery (Licence: TN 6715) | |
| Enumeration Date | 2025-11-13 |
| Last Update Date | 2026-02-04 |