| NPI | 1447480611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME137598) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD60632975) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2018-08-16 |