| NPI | 1639459233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2018002738) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IL 125060698) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT-204442) | |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2018-09-22 |