| NPI | 1730148487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101242298) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD060190L) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2021-07-13 |