| NPI | 1790124691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 284117) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA MCS004591A) |
| 207T00000X Neurological Surgery (Licence: MA 281414) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-09-21 |