| NPI | 1104961010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: DC MD33327) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MD D0065968) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2012-03-15 |