| NPI | 1609138841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 5101020078) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 20A16498) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2025-03-05 |