| NPI | 1790213114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX V7588) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT213088) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2025-06-25 |