| NPI | 1245231604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 218149) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MI 4301087790) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-10-17 |