| NPI | 1376757245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TN MD0000049820) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD445452) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2022-03-16 |