| NPI | 1851395826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 181810-4) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35083857) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2012-01-04 |