| NPI | 1669507984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: UT 262635-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 262635-1205) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2012-09-12 |