| NPI | 1700179363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101264652) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CO DR.0059437) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: CO 0059437) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2022-12-20 |