| NPI | 1275563918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME113032) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 2004001663) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-11-14 |