| NPI | 1649716259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX U3914) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 156050) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2023-08-04 |