| NPI | 1902872955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PA MD067109L) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 213376) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2021-03-04 |