| NPI | 1639495922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2019019454) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 079736) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2019-08-12 |