| NPI | 1205196953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2018-02463) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME121544) |
| Enumeration Date | 2012-05-28 |
| Last Update Date | 2021-10-18 |