| NPI | 1629420963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD470773) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA F444 Section 2113) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2022-07-21 |