| NPI | 1962764480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A135568) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.139582) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-02-08 |