| NPI | 1952768384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME172227) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AR E-17095) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2025-04-24 |