| NPI | 1801167895 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 292928) | 
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: IL 036.139458) | 
| Enumeration Date | 2012-01-23 | 
| Last Update Date | 2018-06-07 |