| NPI | 1629363213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD60955538) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WA MD60955538) |
| 207T00000X Neurological Surgery (Licence: DC NA) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2020-12-02 |