| NPI | 1730666272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 69363) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL15189) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2023-09-21 |