| NPI | 1881858553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA 20A11110) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OR DO176559) |
| 207T00000X Neurological Surgery (Licence: VA 0116020613) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2020-06-22 |