| NPI | 1720246275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME98749) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 243622-1) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2025-10-10 |