| NPI | 1023540630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 324704) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 3902000) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2024-06-11 |