| NPI | 1508272899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NE 28236) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA MD.11968R) |
| 207T00000X Neurological Surgery (Licence: OH 35.130672) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2017-03-13 |