| NPI | 1134121981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA08685200) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX L7319) |
| 207T00000X Neurological Surgery (Licence: PA MD070105L) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-04-26 |