| NPI | 1255567756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2022-00820) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA L-240370) |
| 207T00000X Neurological Surgery (Licence: WA MD60639164) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2022-08-04 |