| NPI | 1962795336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 278233) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: VA 0101253072) |
| 207T00000X Neurological Surgery (Licence: TX R6306) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2019-09-08 |