| NPI | 1942427117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 58653) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: KY TP326) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2014-12-30 |