| NPI | 1518921139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX M6527) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 21890) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2013-03-12 |