| NPI | 1962408930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA ME96941) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 054606) |
| 207T00000X Neurological Surgery (Licence: FL ME96941) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2019-12-19 |