| NPI | 1730594805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL OS17401) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 5101021284) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-08-18 |