| NPI | 1275829996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OR MD189733) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ 72595) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-12-01 |