| NPI | 1689993172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2025-01097) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: VA 0101262318) |
| 207T00000X Neurological Surgery (Licence: KS 04-51432) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197904) | |
| 207T00000X Neurological Surgery (Licence: MD D0089530) | |
| 207T00000X Neurological Surgery (Licence: PA MT197904) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2025-11-18 |