| NPI | 1649569302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME141219) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD466095) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2019-09-20 |