| NPI | 1265409064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 35395) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TN MD14839) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-11-04 |