| NPI | 1053667303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: KY 55547) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 57.021021) |
| 207T00000X Neurological Surgery (Licence: KY TP065) | |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2022-05-02 |