| NPI | 1699965442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD60440903) |
| Additional Taxonomies | 174400000X Specialist |
| 207T00000X Neurological Surgery (Licence: OH 35092472) | |
| 208000000X Pediatrics (Licence: WA MD60440903) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2014-03-28 |