| NPI | 1942819404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX 47709) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA FE61030008) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2022-08-02 |