| NPI | 1700879392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD014650E) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 19199) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-08-13 |