| NPI | 1558596627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 1022751) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX r0777) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2025-08-26 |