| NPI | 1578125522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA66276) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 10208) |
| 207T00000X Neurological Surgery (Licence: CA PA66276) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2025-06-24 |