| NPI | 1720353873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MT MED-PHYS-LIC-132331) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: VA 0101266636) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2024-04-25 |