| NPI | 1902162332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA GFE11935) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA GFE11935) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2012-04-10 |