| NPI | 1700896552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NE 31812) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 4821912-1205) |
| 207T00000X Neurological Surgery (Licence: MI EMC0002923) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2023-06-14 |