| NPI | 1487622122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA ETL566) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD044758L) |
| 207T00000X Neurological Surgery (Licence: OH 35.084677) | |
| 207T00000X Neurological Surgery (Licence: RI MD16747) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2020-10-01 |