| NPI | 1386178119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 105351) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301111904) |
| 207X00000X Orthopaedic Surgery (Licence: NY 327326) | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2025-08-15 |