| NPI | 1619161221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 79354) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR E5783) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2022-01-13 |