| NPI | 1275995508 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 85718-20) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WI 85718-20) | 
| 207T00000X Neurological Surgery (Licence: WA MD61529429) | |
| Enumeration Date | 2016-03-25 | 
| Last Update Date | 2025-07-16 |