| NPI | 1710102827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA 60164745) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 059154) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2021-04-07 |