| NPI | 1790040632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A177733) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100891) |
| 207T00000X Neurological Surgery (Licence: MN 66371) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2023-05-05 |