| NPI | 1629462577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CO DR.0067938) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 308151) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2024-01-19 |