| NPI | 1689993172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101262318) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MT197904) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197904) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2022-07-21 |