| NPI | 1508849936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 220233) |
| Additional Taxonomies | 174400000X Specialist (Licence: RI 11401) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-04-22 |