| NPI | 1154515641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PR 13606) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX Q7131) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2023-09-28 |