| NPI | 1629285309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CO DR.0057575) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A97471) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 261194) | |
| 207T00000X Neurological Surgery (Licence: MO 2017010124) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2017-05-11 |