| NPI | 1811423940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2024017003) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 2024-03186) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2025-05-15 |