| NPI | 1598151953 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WI 23415) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 70791) | 
| Enumeration Date | 2015-04-13 | 
| Last Update Date | 2025-07-14 |