| NPI | 1265420509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101257495) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OK 13775) |
| 207T00000X Neurological Surgery (Licence: NY 268200) | |
| 207T00000X Neurological Surgery (Licence: SC 37815) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2015-10-15 |