| NPI | 1598043143 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MS 21587)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AL 31518)  | 
| Enumeration Date | 2011-08-01 | 
| Last Update Date | 2024-07-12 |