| NPI | 1164472841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0102206614) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 2014016499) |
| 207T00000X Neurological Surgery (Licence: FL UO6947) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102602) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-07-11 |