| NPI | 1356088181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD486819) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ 25MA11978100) |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2026-04-08 |