| NPI | 1891462610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9115040) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL PA9115040) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-28 |
| Last Update Date | 2024-01-16 |