| NPI | 1063757821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 268387) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: ZZ 22743) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2014-03-13 |