| NPI | 1548522063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NM MD2019-0572) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT201572) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2023-07-12 |