| NPI | 1639120645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 74738) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MA 74738) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2012-08-16 |