| NPI | 1629228226 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: AZ 47075)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY Not applicable)  | 
| 207T00000X Neurological Surgery (Licence: FL 17998)  | |
| Enumeration Date | 2008-09-19 | 
| Last Update Date | 2018-11-01 |