| NPI | 1457560906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME113574) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: VA 0101247523) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016383) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-09-05 |