| NPI | 1003814914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: SC 19316) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 9500499) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2026-05-15 |