| NPI | 1003232802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 91783) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 149404) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2022-06-28 |