| NPI | 1568968519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME173830) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4351027570) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2025-05-21 |