| NPI | 1477764066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD00047911) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: UT 5011520-1205) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-03-08 |