| NPI | 1245389931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ MA074054) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: OH 35087495) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-10-17 |