| NPI | 1417921255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA09106700) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD426268) |
| 174400000X Specialist (Licence: NJ 25MA09106700) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2017-01-20 |