| NPI | 1578731212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: LA MD.200761) |
| Additional Taxonomies | 2085N0700X (Licence: LA MD.200761) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2013-01-02 |