| NPI | 1518306497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME140187) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA MD.206068) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-03-30 |