| NPI | 1336436377 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX S0875) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35129899) | 
| Enumeration Date | 2011-06-28 | 
| Last Update Date | 2022-02-04 |