| NPI | 1871781534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAROOK J KIDWAI Owner 315-755-6099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 140410168) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2018-03-17 |