| NPI | 1982663340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: LA MD.07590R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA L07590R) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2013-04-05 |