| NPI | 1801288816 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MD D0091825) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WI 62323-20) | 
| 207T00000X Neurological Surgery (Licence: AZ 51533) | |
| Enumeration Date | 2015-02-27 | 
| Last Update Date | 2021-06-28 |