| NPI | 1659364412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX H3003) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 206001) |
| 207T00000X Neurological Surgery (Licence: NH 11048) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2012-01-23 |