| NPI | 1619430600 |
|---|---|
| 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: MA 1027505) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2026-04-30 |