| NPI | 1831543925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 103880) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 1013762) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2025-09-16 |