| NPI | 1932147659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY 22076) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MO R6H49) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2013-08-24 |