| NPI | 1639664733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 103763) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 276624) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2025-06-17 |