| NPI | 1720321086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL ME172844) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NJ 25MA11957100) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2025-07-01 |