| NPI | 1275763591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 85121) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35130493) |
| 207T00000X Neurological Surgery (Licence: LA 302251) | |
| 207T00000X Neurological Surgery (Licence: MI 4301094040) | |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2020-07-09 |