| NPI | 1073979332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: RI MD18382) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A147705) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-01-02 |
| Last Update Date | 2022-05-25 |