| NPI | 1366649840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD60572773) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OR MD172171) |
| 207T00000X Neurological Surgery (Licence: MO 2014007656) | |
| 208600000X Surgery (Licence: WA 60572773) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2021-03-31 |