| NPI | 1952153389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA 00035770) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A20730) |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-04-01 |