| NPI | 1083692917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101255217) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 46914) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2022-01-24 |