| NPI | 1104208305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 69482) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2023-01-06 |