| NPI | 1962602193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: ME MD28964) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.123589) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2025-04-15 |