| NPI | 1023094950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101259100) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 2011-01173) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2021-11-10 |