| NPI | 1730409541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CT 059992) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: RI MD15817) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2019-09-20 |