| NPI | 1770715559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 79620) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A137553) |
| 207T00000X Neurological Surgery (Licence: MN 108344) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193737) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2019-10-08 |