| NPI | 1467680678 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: SC 39958) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WI 39958) | 
| 207T00000X Neurological Surgery (Licence: WA MD60530040) | |
| 207T00000X Neurological Surgery (Licence: IL 125-056805) | |
| Enumeration Date | 2009-06-25 | 
| Last Update Date | 2025-02-17 |