| NPI | 1922652759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0009513) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 29770) |
| 207T00000X Neurological Surgery (Licence: KY FL0678) | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2022-12-09 |