| NPI | 1083623193 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA C51196) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GU M-2397) |
| 207T00000X Neurological Surgery (Licence: OR MD151115) | |
| 207T00000X Neurological Surgery (Licence: GU MTL-2023-017) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2025-01-03 |