| NPI | 1174965651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: SC 83493) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MT204491) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2024-04-15 |