| NPI | 1639292287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME113907) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301085448) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-10-10 |