| NPI | 1710366695 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A177211)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 61185)  | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-25 | 
| Last Update Date | 2022-06-30 |