| NPI | 1689819146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301030979) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: UT 71333641205) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |