| NPI | 1376805218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101269846) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: SC LL34898) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2023-08-10 |