| NPI | 1871940718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX V7997) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: RI LP03693) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2025-08-15 |