| NPI | 1821212176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: LA 03684R) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA 03684R) |
| 2085N0700X (Licence: LA 03684R) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2018-06-13 |