| NPI | 1891317152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 1016603) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 2020-00234) |
| Enumeration Date | 2020-05-09 |
| Last Update Date | 2024-05-02 |