| NPI | 1053374835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MO 2017000597) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 225485) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-01-27 |