| NPI | 1811273287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX R3079) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 273812) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2026-02-20 |