| NPI | 1861750713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A169285) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CT 63998) |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2022-05-16 |