| NPI | 1629761994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT232242) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IA R-12779) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2024-06-18 |