| NPI | 1114913605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY 40238) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX M8421) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2014-06-24 |