| NPI | 1952978181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 331751) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 74948) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 32163) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-09-04 |