| NPI | 1366436602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101034306) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: DC MD10872) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2009-12-14 |