| NPI | 1417178641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CO 45973) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR MD153449) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2017-09-01 |