| NPI | 1013143627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX Q2893) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01068414A) |
| 207T00000X Neurological Surgery (Licence: VA 0101263882) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2024-04-19 |