| NPI | 1588645485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 235835) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CT 030014) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2017-08-01 |