| NPI | 1750587036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2018-01242) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101258885) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2021-03-30 |