| NPI | 1700806452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NM TT2007-0711) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: NM TT2007-0711) |
| 246Z00000X Specialist/Technologist, Other (Licence: NY DABNM45) | |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: NY DABNM45) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2008-04-25 |