| NPI | 1609029255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G39009) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA G39009) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |