| NPI | 1104521483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 80584) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 34422) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2025-08-21 |