| NPI | 1053375758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 5101017055) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 34.006663) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2015-09-24 |