| NPI | 1659552818 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OR MD153823)  | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO 2011037566)  | 
| Enumeration Date | 2007-11-16 | 
| Last Update Date | 2021-05-18 |