| NPI | 1063699833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2015011447) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX n8651) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.002373) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2021-02-23 |