| NPI | 1629244884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 260313-1) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA 75452) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2022-07-21 |