| NPI | 1194949594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA OP60323732) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 5101017134) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-05-11 |