| NPI | 1780113878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA059033) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MA059033) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2017-07-18 |