| NPI | 1609371897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX W4066) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CO DR.0075028) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2026-06-17 |