| NPI | 1073828794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA OP60625254) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 5101018064) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2016-06-23 |