| NPI | 1003011339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME116162) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD61014044) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-06-29 |