| NPI | 1275748212 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MI 4301100714) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH NONE) |
| 207T00000X Neurological Surgery (Licence: FL ME145997) | |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2023-10-13 |