| NPI | 1639716335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 57.248420) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL ME152902) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2021-11-08 |