| NPI | 1811157613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2012-00452) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 224857) |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2025-07-15 |