| NPI | 1528201118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA10821200) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD60544491) |
| Enumeration Date | 2009-04-12 |
| Last Update Date | 2021-06-02 |