| NPI | 1639497563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX N5028) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IL 036.124002) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2015-11-19 |