| NPI | 1760138796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA C176615) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 176615) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2022-03-17 |