| NPI | 1831522184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TN UTRESIDENT) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA4799) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2024-06-17 |