| NPI | 1164534301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 1578071) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ MA68391) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-04-16 |