| NPI | 1053319129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2016-01599) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD050194L) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2016-07-08 |