| NPI | 1417154733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 275213) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NH RT-1751) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-01-20 |