| NPI | 1730150913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: SC 1549) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 11549) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2012-12-21 |