| NPI | 1063668440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME124819) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 51882) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2020-08-31 |