| NPI | 1881866424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX N1810) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MD D0065457) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2011-01-20 |