| NPI | 1922794403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 334335) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME174354) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2025-09-09 |