| NPI | 1275696650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 2012-00919) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 098472) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2012-08-31 |