| NPI | 1790764850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WV 24728) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301070369) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-04-05 |