| NPI | 1174775993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA08014900) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: PA MD436506) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2012-06-27 |