| NPI | 1114106820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: ND 11568) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207T00000X Neurological Surgery (Licence: MN 56052) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2024-08-20 |