| NPI | 1477525970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: AL 37118) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY PA722) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207T00000X Neurological Surgery (Licence: NY 281802-1) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2018-07-05 |