| NPI | 1396277059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WV 33766) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 33766) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2024-06-11 |