| NPI | 1275976540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD474698) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: RI MD17042) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2025-02-21 |