| NPI | 1679890701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OK 32880) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301109314) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 0000000) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2020-10-07 |