| NPI | 1366903536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 332735) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA 332735) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2022-09-02 |