| NPI | 1124429923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX Q6519) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 277227) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2019-12-06 |