| NPI | 1548587884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD460679) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 62952) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2017-07-20 |