| NPI | 1265432603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA07924300) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 15788) |
| 207T00000X Neurological Surgery (Licence: PA MD420330) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2008-04-03 |