| NPI | 1063452514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 1466681) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA06554700) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-07-03 |