| NPI | 1073666095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME98127) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 46970) |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2015-08-13 |