| NPI | 1063941672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD.MD.70087455) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX BP10060509) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2026-08-13 |