| NPI | 1659367456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME156419) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OR UD 18984) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2022-09-19 |