| NPI | 1649495896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD.MD.60118966) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OR MD188640) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2023-03-30 |