| NPI | 1760549208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX R0491) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD00026698) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2017-01-17 |