| NPI | 1912092800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 64254) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 092997) |
| 207T00000X Neurological Surgery (Licence: CA A95987) | |
| 207T00000X Neurological Surgery (Licence: MO 2004019701) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-03-26 |