| NPI | 1710542584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL TRN33043) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA pending) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2023-10-25 |