| NPI | 1790765485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WI 71825) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 43762) |
| 207T00000X Neurological Surgery (Licence: FL ME113558) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-05-07 |