| NPI | 1457619967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2025-01647) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: SC 52310) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2025-05-30 |