| NPI | 1972683068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA G78763) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX M7906) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2017-07-03 |