| NPI | 1205017605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OR MD27964) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: DC MD035600) |
| 207T00000X Neurological Surgery (Licence: WA MD60101352) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2014-03-07 |