| NPI | 1700630498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY TP298) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 76766) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2026-05-13 |