| NPI | 1699062596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX R7286) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT-200223) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2018-05-14 |