| NPI | 1538113360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD014442E) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 1131781) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-10-20 |