| NPI | 1235557968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD61181935) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX R9298) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-11-11 |