| NPI | 1134369556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OK 31253) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN 12140) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2020-01-24 |