| NPI | 1568522035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NM MD2013-0879) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD00040264) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-07-21 |