| NPI | 1669672960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX P9408) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 231568) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2014-09-02 |