| NPI | 1588000483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OR DO195159) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA OP60990980) |
| 207T00000X Neurological Surgery (Licence: MI 5101020297) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2021-03-15 |