| NPI | 1013182294 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: DC MD038461)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MD D0075270)  | 
| 207T00000X Neurological Surgery (Licence: VA 0116018620)  | |
| Enumeration Date | 2008-04-28 | 
| Last Update Date | 2013-09-13 |