| NPI | 1649620238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: LA 306517) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 269166) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2024-02-26 |