| NPI | 1255337663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD.MD.60799736) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OR MD23736) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2026-07-02 |