| NPI | 1811151772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: LA MD.208098) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AZ R70249) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2015-11-12 |