| NPI | 1770563561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0101232364) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 29836) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2022-04-08 |