| NPI | 1508608613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME175216) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WI 82166-20) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2025-11-04 |