| NPI | 1114240173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301102200) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301102200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2013-07-31 |