| NPI | 1952768384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY TP030) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2016-0551) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2022-07-21 |