| NPI | 1083103394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2026-01156) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: SC MMD.96178) |
| 207T00000X Neurological Surgery (Licence: OH 35.153024) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2026-06-16 |