| NPI | 1558655811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A108222) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A108222) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2017-01-05 |