| NPI | 1730625450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TN MD65163) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MS 33767) |
| 207T00000X Neurological Surgery (Licence: PA MD464037) | |
| 207T00000X Neurological Surgery (Licence: FL ME137345) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2026-07-15 |