| NPI | 1730189168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA07899300) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WA MD0004425) |
| 207T00000X Neurological Surgery (Licence: NY 225989-1) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-08 |