| NPI | 1801930573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 273807) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MD D0070049) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2014-06-19 |