| NPI | 1235525163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A191826) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61259064) |
| 207T00000X Neurological Surgery (Licence: WA 61259064) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2026-05-19 |