| NPI | 1811083991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MA06357600) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD039908E) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-08-09 |