| NPI | 1699032961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD61037785) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WI 61827 - 20) |
| 207T00000X Neurological Surgery (Licence: CA A159873) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-05-24 |