| NPI | 1801250808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: ID M-17256) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 76326) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-06-30 |