| NPI | 1518344373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2022-02706) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME150032) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2022-10-21 |