| NPI | 1619289428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NC 201902081) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 262068) |
| 207T00000X Neurological Surgery (Licence: OH 35.131733) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2022-12-14 |