| NPI | 1346591609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CT 72990) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 57.020807) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2023-06-01 |