| NPI | 1831075878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 15423) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 15423) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2025-09-25 |