| NPI | 1053792481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 35.146353) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD478077) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT208531) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-09-13 |