| NPI | 1053682971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A168233) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MD D0082850) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2021-11-03 |