| NPI | 1821319682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101263406) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME137026) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2026-07-08 |