| NPI | 1669769352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: OH 35.133009) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301098833) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098833) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2018-06-28 |