| NPI | 1548430754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX P6951) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD442978) |
| 207T00000X Neurological Surgery (Licence: OH 35.092165) | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2021-08-19 |