| NPI | 1104072545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A115268) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 52846) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2021-04-19 |