| NPI | 1740969831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL 38409) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 38409) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: FL 38409) | |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-14 |