| NPI | 1487871349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME121057) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.085886) |
| 207T00000X Neurological Surgery (Licence: CO DR.0057310) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2024-04-03 |