| NPI | 1790753622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD071222L) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 300246) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2019-10-16 |