| NPI | 1336404771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 309610) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL 143873) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2022-12-06 |