| NPI | 1710182118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PR 18773) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD453666) |
| 207T00000X Neurological Surgery (Licence: WA 60429825) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2019-12-17 |