| NPI | 1417410515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WI 73759-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 73759-20) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2026-06-09 |