| NPI | 1902491301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114053) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL PA9114053) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9114053) | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2022-09-08 |