| NPI | 1669765426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 279672) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A155671) |
| 207T00000X Neurological Surgery (Licence: PA MT199195) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2019-07-02 |