| NPI | 1639136021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX D7148) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.130528) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2017-11-14 |