| NPI | 1457610776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX S6611) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT-203882) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-04-07 |