| NPI | 1124040308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101239907) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA MD.205983) |
| 207T00000X Neurological Surgery (Licence: PA MD439010) | |
| 207T00000X Neurological Surgery (Licence: NJ 25MA08803500) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2026-06-02 |