| NPI | 1821101395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: ID M4548) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MT 11999) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2022-05-24 |