| NPI | 1497103519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD469564) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-02-10 |