| NPI | 1619167954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME151776) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IA 40396) |
| 207T00000X Neurological Surgery (Licence: LA MD.200930) | |
| 208000000X Pediatrics (Licence: IA 40396) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2026-08-12 |