| NPI | 1497285886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY FL057) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 272878) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-07-21 |