| NPI | 1780384875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301511840) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ 69441) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2026-02-02 |