| NPI | 1962457903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA G68193) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA G68193) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-07-08 |