| NPI | 1326576489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101285307) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 0) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2025-08-25 |