| NPI | 1124254917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 273606) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207T00000X Neurological Surgery (Licence: KY TP008) | |
| Enumeration Date | 2009-06-07 |
| Last Update Date | 2016-09-27 |