| NPI | 1215463914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 20A16756) |
| 207T00000X Neurological Surgery (Licence: FL OS20696) | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2024-08-14 |