| NPI | 1487751962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C32503) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA C32503) |
| 207T00000X Neurological Surgery (Licence: CA C32503) | |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2014-01-28 |