| NPI | 1417937426 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX J8311) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA MD.204211) | 
| Enumeration Date | 2006-01-18 | 
| Last Update Date | 2021-03-29 |