| NPI | 1790104610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD476271) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PR 000) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2022-02-15 |