| NPI | 1154734606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL OS18866) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2014-0559) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-06-27 |