| NPI | 1255176194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD.MD.70130425) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD.MD.70130425) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2026-07-08 |