| NPI | 1609928084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 35.132936) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA CA126321) |
| 208600000X Surgery (Licence: TN MD0000043868) | |
| 208600000X Surgery (Licence: MD T1609) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-01-07 |