| NPI | 1649527573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME139595) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX P 9908) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2019-04-16 |