| NPI | 1497287734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY TP273) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL OS21210) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2025-05-30 |