| NPI | 1669469227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WY 9823A) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: VA 0101238532) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2019-12-12 |