| NPI | 1134575186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY TP470) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ 68671) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2025-06-13 |