| NPI | 1326481052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA ML.60367968) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: KY TP997) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-04-27 |