| NPI | 1528009198 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TN MD34821)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 40265)  | 
| 207T00000X Neurological Surgery (Licence: VA 0101247383)  | |
| 207T00000X Neurological Surgery (Licence: GU MTL-2023-001)  | |
| 207T00000X Neurological Surgery (Licence: GU M-2375)  | |
| Enumeration Date | 2006-06-08 | 
| Last Update Date | 2023-04-21 |