| NPI | 1366791725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 277266) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CT 54083) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2016-05-15 |