| NPI | 1104021054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA08346700) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35089924) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2011-01-19 |