| NPI | 1477661114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 35.133151) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301406954) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2018-05-16 |