| NPI | 1164472916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: RI CMD13914) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX L7897) |
| 207T00000X Neurological Surgery (Licence: NJ 25MA08656300) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2013-08-15 |