| NPI | 1003135013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 63984) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 57.030527) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2018-06-22 |