| NPI | 1770015133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD60672612) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CO DR.0057045) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2018-07-02 |