| NPI | 1013470988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL 180454) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 313312) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2026-07-12 |