| NPI | 1528796869 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME170429) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IL 036.173112) | 
| 207T00000X Neurological Surgery (Licence: WI 86127-20) | |
| 2085N0700X (Licence: WI 86127-20) | |
| Enumeration Date | 2022-08-14 | 
| Last Update Date | 2025-09-24 |