| NPI | 1497240311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME176223) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: SC LL52747) |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2025-08-27 |