| NPI | 1003339185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD475216) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.137605) |
| 208D00000X General Practice (Licence: PA MD475216) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2025-08-27 |