| NPI | 1861413536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX N2167) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 28512) |
| 207T00000X Neurological Surgery (Licence: GA 039151) | |
| 207T00000X Neurological Surgery (Licence: SC 27496) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: TX N2167) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-02-09 |