| NPI | 1245230143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OR MD19851) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: SD 5552) |
| 207T00000X Neurological Surgery (Licence: ND 10071) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2013-08-23 |