| NPI | 1659990224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: RI MD20425) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A165517) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-04-02 |