Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 12183 | SD |
N | 207T00000X | Neurosurgeon | 57 . 020833 | OH |
NPI | 1033454194 |
---|---|
Provider Name | John Roufail |
First Address | Rocky River, OH 44116-1053 |
Second Address | Sioux Falls, SD 57104-4650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2012 |
Last Update Date | 25/11/2020 |