| NPI | 1194721308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 89571) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 89571) |
| 207T00000X Neurological Surgery (Licence: CA G72753) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-10-31 |