| NPI | 1821093345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301064490) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI MJ064490) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-07-07 |