Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | R4470 | TX |
NPI | 1053625624 |
---|---|
Provider Name | Dr. Jonathan Sellin |
First Address | Houston, TX 77030-2726 |
Second Address | Houston, TX 77030-2726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2010 |
Last Update Date | 12/03/2020 |