| NPI | 1891144044 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: SC 91972)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 008350)  | 
| 207T00000X Neurological Surgery (Licence: AZ 69109)  | |
| Enumeration Date | 2016-06-08 | 
| Last Update Date | 2025-03-03 |