| NPI | 1538574991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: AZ 57782) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA 131107) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2019-08-29 |