| NPI | 1902123128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 109069) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207T00000X Neurological Surgery (Licence: GA 77695) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2017-04-18 |