| NPI | 1477962876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NM MD2020-1026) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT207668) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2021-06-17 |