| NPI | 1043656051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101284376) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NV 19425) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2025-12-22 |