| NPI | 1619672839 |
|---|---|
| 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: NY 340042-1) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2025-10-07 |