| NPI | 1316685589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 57.253455) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 81194) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2026-01-21 |