| NPI | 1801343421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD470776) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A194888) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2025-08-14 |