| NPI | 1104945997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101241479) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 29697) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-07-28 |