| NPI | 1043730112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME173547) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: RI MD19639) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 272675) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-08-04 |