| NPI | 1982139077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD488205) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35.150849) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2025-07-03 |