| NPI | 1053587865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX R2945) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ 25MA09049100) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2020-02-03 |