| NPI | 1972765600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CT 055248) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207T00000X Neurological Surgery (Licence: PA MD454216) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2016-06-20 |