| NPI | 1295909901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA 60081909) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC TRAINING LICENSE) |
| 207T00000X Neurological Surgery (Licence: WI 54287) | |
| 207T00000X Neurological Surgery (Licence: MN 52761) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2015-02-17 |