| NPI | 1922094614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME124772) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301062572) |
| 208D00000X General Practice (Licence: MI 4301062572) | |
| 207T00000X Neurological Surgery (Licence: MI 4301062572) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2015-10-23 |