| NPI | 1790048593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2019-02571) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182431) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2021-04-02 |