| NPI | 1871154682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NJ 25MP00552300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00552300) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 024401) | |
| Enumeration Date | 2019-06-23 |
| Last Update Date | 2022-05-06 |