| NPI | 1255875803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX 47795) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL003987) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2022-11-22 |