| NPI | 1205377793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: ND 15334) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD60774415) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2022-07-11 |