| NPI | 1215114475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 076431) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35098259) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2023-10-02 |