| NPI | 1356690374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301504670) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 25404) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2021-09-08 |