| NPI | 1619902400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 156882) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ 25MA05172400) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-01-06 |