| NPI | 1902154701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 291026) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: ME MD23583) |
| 207T00000X Neurological Surgery (Licence: RI MD16722) | |
| 207T00000X Neurological Surgery (Licence: PR 23046) | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2023-09-09 |