| NPI | 1154676534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: AZ 68488) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 253344) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2024-02-14 |