| NPI | 1861617755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME112576) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CO DR.0070273) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207T00000X Neurological Surgery (Licence: NJ 25MA09068200) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-10-18 |