| NPI | 1659899342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301114554) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IA R11042) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2018-06-19 |