| NPI | 1770171209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: AR R-4723) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX BP10070071) |
| Enumeration Date | 2021-01-10 |
| Last Update Date | 2022-04-12 |