| NPI | 1457671976 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 89329) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME133960) | 
| Enumeration Date | 2010-06-07 | 
| Last Update Date | 2021-10-27 |