| NPI | 1578978946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX T1893) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MT206903) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-06-21 |