| NPI | 1528398203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX N9901) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL TRN 13342) |
| Enumeration Date | 2010-01-02 |
| Last Update Date | 2021-04-29 |