| NPI | 1619965316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO R8N28) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME127387) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2021-04-07 |