| NPI | 1053304204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: UT 7915443-1205) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OK 19641) |
| 207T00000X Neurological Surgery (Licence: WY 8937A) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2019-01-11 |