| NPI | 1376681619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME97619) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA 09098R) |
| 207T00000X Neurological Surgery (Licence: CA G87914) | |
| 207T00000X Neurological Surgery (Licence: TX M5448) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2011-08-02 |