| NPI | 1720220940 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301114391) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 284994) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2022-04-28 |