| NPI | 1215457809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX V2717) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 2017020107) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2025-08-27 |