| NPI | 1285791905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 227303-1) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: NY 227303-1) |
| 302F00000X Exclusive Provider Organization (Licence: NJ 25MA07796800) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2014-03-25 |