| NPI | 1649690751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MA 278575) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.141728) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-10-18 |