| NPI | 1306697883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A199767) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 100450) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2025-07-01 |