| NPI | 1619296068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TN MD5529) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: TN MD5529) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2010-06-10 |