| NPI | 1801250121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD61378213) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX BP10057939) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-06-30 |