| NPI | 1346642501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD70014395) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL 161888) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2025-10-15 |