| NPI | 1750611158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX Q2719) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD60123870) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2017-05-02 |