| NPI | 1013168004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101253786) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101253786) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2016-08-01 |