| NPI | 1417137290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101263741) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX P1718) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2021-07-13 |