| NPI | 1104002047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MS 20183) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX N4161) |
| 207T00000X Neurological Surgery (Licence: WI 56920) | |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2020-08-11 |