| NPI | 1841233087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD425309) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A20299) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 34581) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |