| NPI | 1710244280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 5101028392) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA OP60448673) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2025-01-15 |