| NPI | 1356559199 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX N1587)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AL 26226)  | 
| 207T00000X Neurological Surgery (Licence: CO 47893)  | |
| Enumeration Date | 2007-05-17 | 
| Last Update Date | 2025-01-17 |