| NPI | 1174535132 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MT 42412) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD430623) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2022-07-21 |