| NPI | 1801200753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX T0606) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ R74463) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-10-13 |