| NPI | 1346774601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: VA 0102209919) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 34.017470) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2026-02-24 |