| NPI | 1568789188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: ND 12393) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 237731) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2012-09-14 |