| NPI | 1902240484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101274303) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME149266) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2022-06-24 |