| NPI | 1073909024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CT 70711) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 315487) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-10-04 |