| NPI | 1962908368 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 275550) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ 75480) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-04 | 
| Last Update Date | 2025-06-19 |