| NPI | 1689087892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 56621) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA PA56621) |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2021-12-03 |