| NPI | 1114900966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 10384) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 10384) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2021-03-11 |