| NPI | 1376643619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301093493) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA md429805) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2021-04-06 |