| NPI | 1598105280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NV DO2514) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 5101020496) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-02-25 |