| NPI | 1043203706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME143543) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: KY 39059) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2020-02-10 |