| NPI | 1063855153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD470402) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ 25MA10829700) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2020-12-14 |