| NPI | 1720051501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY 23998) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: KY 23998) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: KY 23998) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2017-01-24 |