| NPI | 1205279650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2019029089) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 59069) |
| 207T00000X Neurological Surgery (Licence: MN 59069) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2023-05-30 |