| NPI | 1215920855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: LA 10605R) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MS 22519) |
| 207T00000X Neurological Surgery (Licence: TN MD0000031606) | |
| 207T00000X Neurological Surgery (Licence: MO 2013003221) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2022-07-21 |