| NPI | 1720338452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2023042922) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME156531) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2023-12-06 |