| NPI | 1265937536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY R4833) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207T00000X Neurological Surgery (Licence: NC 2025-02232) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2026-08-04 |