| NPI | 1053500314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: UT 8823947-1205) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 57013073) |
| 207T00000X Neurological Surgery (Licence: MI 4301102092) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2016-02-10 |