| NPI | 1124082755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA G55925) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 072598) |
| 207T00000X Neurological Surgery (Licence: MI 301111583) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 207T00000X Neurological Surgery (Licence: MN 40508) | |
| 207T00000X Neurological Surgery (Licence: WA MD00046622) | |
| 207T00000X Neurological Surgery (Licence: FL ME60083) | |
| 207T00000X Neurological Surgery (Licence: NY 246231) | |
| 207T00000X Neurological Surgery (Licence: PA 042414-L) | |
| 207T00000X Neurological Surgery (Licence: NJ 25MA05469000) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-03-07 |