| NPI | 1790171338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: SC 87689) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 2022-02065) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2025-01-08 |