| NPI | 1790122141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: LA 330499) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IL 125.063144) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2022-08-11 |