| NPI | 1699305300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35.154724) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MDRE.ML.61312286) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2025-10-16 |