| NPI | 1447785662 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A156901) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD61468908) | 
| Enumeration Date | 2017-04-25 | 
| Last Update Date | 2025-08-19 |