| NPI | 1790367530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH APP-000461726) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-22 |