| NPI | 1851612972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD61104836) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 54167) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2021-11-09 |