| NPI | 1780649590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CO 0056272) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MT 11163) |
| 207T00000X Neurological Surgery (Licence: NY 259529) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K9644) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2018-06-29 |