| NPI | 1265588164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD460414) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA G39657) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2022-07-21 |