| NPI | 1629175989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2025042674) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: KY 29737) |
| 207T00000X Neurological Surgery (Licence: MI 4301086873) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-12-02 |